Interactive Headache Flowchart

This is a strategy for trying to get rid of the acute headache once it has started. For the best outcome the patient needs to initiate these measures as soon as they feel the pain coming on. There isn't any evidence to show that taking the rescue regime at the start of the aura is any better.

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The current NICE guidelines state that for the best chance of getting rid of the headache they patient should 'hit it with everything', in other words take non-steroidal anti-inflammatory drugs (NSAIDS), a triptan and an antiemetic that promotoes stomach emptying at the same time. Common sense would suggest that is a patients finds that one or two of these works fine then the would not necessarily need to take all three.

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The doses suggested here, particularly for the NSAIDS, are large but you really are trying to get rid of the pain right at the start so the hope is that only one, very large dose, will be needed.

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Treatment of acute migraines can include:

1.  Non-pharmacological treatments

2. NSAIDS

3. Triptans

4. Anti-emetics

5. Some or all of these together.

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In some cases the headache just won't shift, in which case there are some third line strategies which should only really be instituted under specialist guidance.